Cognitive, Emotional, and Social Processes in Psychosis: Refining Cognitive Behavioral Therapy for Persistent Positive Symptoms

King's College London, Institute of Psychiatry, Department of Psychology, PO Box 77, London SE5 8AF, UK.
Schizophrenia Bulletin (Impact Factor: 8.61). 11/2006; 32 Suppl 1(suppl 1):S24-31. DOI: 10.1093/schbul/sbl014
Source: PubMed

ABSTRACT Psychosis used to be thought of as essentially a biological condition unamenable to psychological interventions. However, more recent research has shown that positive symptoms such as delusions and hallucinations are on a continuum with normality and therefore might also be susceptible to adaptations of the cognitive behavioral therapies found useful for anxiety and depression. In the context of a model of cognitive, emotional, and social processes in psychosis, the latest evidence for the putative psychological mechanisms that elicit and maintain symptoms is reviewed. There is now good support for emotional processes in psychosis, for the role of cognitive processes including reasoning biases, for the central role of appraisal, and for the effects of the social environment, including stress and trauma. We have also used virtual environments to test our hypotheses. These developments have improved our understanding of symptom dimensions such as distress and conviction and also provide a rationale for interventions, which have some evidence of efficacy. Therapeutic approaches are described as follows: a collaborative therapeutic relationship, managing dysphoria, helping service users reappraise their beliefs to reduce distress, working on negative schemas, managing and reducing stressful environments if possible, compensating for reasoning biases by using disconfirmation strategies, and considering the full range of evidence in order to reduce high conviction. Theoretical ideas supported by experimental evidence can inform the development of cognitive behavior therapy for persistent positive symptoms of psychosis.

Download full-text


Available from: Elizabeth Kuipers, Jul 04, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cognitive behavioral therapy for psychosis (CBTp) has enjoyed a steep rise in popularity over the past 15 years; however, recent systematic reviews and meta-analyses have concluded that CBTp has only modest effects on psychotic syndrome outcomes and that empirical evidence of its superiority over other psychosocial treatments is poor. And although it has been argued by some prominent authors that CBTp is not designed to alleviate the “psychotic syndrome,” there is little empirical evidence linking CBTp change mechanisms with syndrome versus single-symptom outcome measures. This study investigated the relationship between CBTp change processes, beliefs about voices, and thought control strategies, with a range of outcome measures including global positive psychotic symptoms in a sample of 40 voice hearers with established diagnosis of psychotic disorder. Consistent with the assertions of Birchwood and Trower (2006), global positive symptoms were found to be generally poorly related to CBTp change processes. Conversely, these CBTp change processes were found to be generally strongly related to measures of emotional distress and some measures of single psychotic symptoms. The implications for past and future CBTp treatment outcome studies are discussed.
    Journal of Cognitive Psychotherapy 05/2014; 28(2). DOI:10.1891/0889-8391.28.2.101
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Responsiveness to cognitive behaviour therapy (CBT) in psychosis may have a neurological basis. This study aimed to determine whether improvement in symptoms following CBT for psychosis (CBTp) in people with schizophrenia is positively associated with pre-therapy grey matter volume in brain regions involved in cognitive processing. Sixty outpatients stable on medication with at least one distressing symptom of schizophrenia and willing to receive CBTp in addition to their standard care (SC), and 25 healthy participants underwent magnetic resonance imaging. Subsequently, 30 patients received CBTp (CBTp+SC; 25 completers) for 6-8 months and 30 continued with their standard care (SC; 19 completers). Symptoms in all patients were assessed (blindly) at entry and follow-up. The CBTp+SC and SC groups did not differ clinically at baseline, and only the CBTp+SC group showed improved symptoms at follow-up. Severity of baseline symptoms was not associated with CBTp responsiveness. Reduction with CBTp in positive symptoms was associated with greater right cerebellum (lobule VII) grey matter volume, in negative symptoms with left precentral gyrus and right inferior parietal lobule grey matter volumes, and in general psychopathology with greater right superior temporal gyrus, cuneus and cerebellum (Crus I) grey matter volumes. Grey matter volume in these brain areas did not correlate with the severity of baseline symptoms. Grey matter volume of the frontal, temporal, parietal and cerebellar areas that are known to be involved in the co-ordination of mental activity, cognitive flexibility, and verbal learning and memory predict responsiveness to CBTp in patients with psychosis.
    Schizophrenia Research 10/2009; 115(2-3):146-55. DOI:10.1016/j.schres.2009.08.007 · 4.43 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous research has suggested that there are multiple psychological processes underlying delusional thought. While it appears that cognitive biases in certain reasoning and attention processes are related to delusion-proneness, the influence of emotion on these processes is not well understood. The overall objective of this study was to investigate the effect of emotional content on performance on tasks thought to measure attentional bias, preferential recall, and probabilistic reasoning in individuals with schizophrenia and demographically matched controls. In order to account for level of delusion-proneness, participants also completed a multidimensional measure of delusional thought. It was hypothesized that individuals with schizophrenia would perform more poorly on both the emotional and neutral versions of these tasks compared to controls. It was also hypothesized that within each group, there would be a statistically significant emotion effect, indicated by a difference in performance on the emotional (compared to neutral) condition of each task. This emotion effect was expected to be larger in the schizophrenia group. Finally, it was hypothesized that the emotion effect would increase as the severity of delusional proneness increased for all participants, regardless of group. As hypothesized, the schizophrenia group performed more poorly on the tasks overall, though expected emotion effects were generally absent. There were no differences in the size of emotion effects between the groups on any of the cognitive tasks administered, and the emotion effect did not appear to increase as severity of delusion-proneness increased. Factors that may have contributed to this pattern of results are discussed. Implications of these findings on theoretical models of delusions and future directions for research in this area are also discussed.